The Value of Cryosurgery in Treating a Case of Thoracic Chondrosarcoma

Chondrosarcomas of the spine are rare and difficult to treat. In this paper a case of thoracic chondrosarcoma is presented. Chondrosarcomas of the spine are generally smaller, more difficult to excise and are followed by higher local recurrence compared with chondrosarcomas of the peripheral skeleton. The tumor is radio- and chemoresistant, making the surgical treatment of utmost importance. The most important prognostic factor for local control is wide or marginal tumor resection. Our patient was treated in two stages, with total excision of the tumor, using cryosurgery. Liquid nitrogen was used to freeze the damaged tissue at a cellular level and made the excision more efficient

DOPPLER-GUIDED HAEMORRHOIDAL ARTERY LIGATION (DGHAL), RECTOANAL REPAIR (RAR), SUTURED HAEMORRHOIDOPEXY (SHP) AND MINIMAL MUCOCUTANEOUS EXCISION (MMCE) FOR GRADE III-IV HAEMORRHOIDS: A MULTICENTER PROSPECTIVE STUDY OF SAFETY AND EFFICACY Running head: DGHA

ABSTRACT Objective: The isolated use of Doppler-guided haemorrhoidal artery ligation (DGHAL) may fail for advanced haemorrhoids (HR) (grades III, IV). Suture haemorrhoidopexy (SHP) and mucopexy by rectoanal repair (RAR) result in haemorrhoidal lifting and fixation. A prospective evaluation was performed to evaluate the results of DGHAL combined with adjunctive procedures. Methods: The study included 147 patients with haemorrhoids (males:102; grade III:95, IV:52) presenting with bleeding (73%) and prolapse (62%). Results: More ligations were required for grade IV than III haemorrhoids (10.7+2.8 vs 8.6+2.2, p<0.001). SHP (28 patients) and RAR (18 patients) at 1-4 positions were deemed necessary in 46 (31%) patients. Minimal (muco-)cutaneous excision (MMCE) was added in 23 patients. SHP/RAR were applied more frequently in Grade IV HR (60% vs 16%, p<0.001). In patients not having MMCE, SHP/RAR were added in 57% of grade IV cases (p<0.001). Complications included residual prolapse (10; 2 second surgery), bleeding (15; 2 second DGHAL), thrombosis (4), fissure (3) and fistula (1). No analgesia was required by 30%, 31%, 16%, 14% of the patients on days 1-3, 4-7 and >7 respectively. SHP/RAR was associated with greater discomfort (17% vs 6%, p<0.001). No differences were found between SHP and RAR. At an average follow-up of 15 months, 96% of patients were asymptomatic and 95% were satisfied. Conclusions: DGHAL with the selective application of SHP/RAR is a safe and effective technique for advanced grade haemorrhoids